Wild animals do not get heart attack, blood pressure, diabetes or stroke. These are all lifestyle disorders. But they can occur in a lion caged in a zoo, a rabbit in a laboratory or a pet dog in the house.

The biggest challenge, therefore, in cardiology internationally is – how to prevent getting lifestyle diseases including heart attack.

Most lifestyle disorders are linked to abdominal obesity which is the latest epidemic in the society in the west and is also becoming an epidemic in urban India which is now gradually shifting to middle class. It is linked to eating white sugar, white rice, white maida and not exercising.

Traditionally, Indian sages knew that Indians are prone to getting abdominal obesity, therefore, they promoted observing fast at least 80 days in a year which involves one fast every week, one extra fast on Ekadashi and two Navratras of nine days each at the onset of summer and winter. Traditionally, the Indian fast includes not eating cereals on the fast day. Avoiding cereals 80 days in a year does not allow a person to develop metabolic syndrome and insulin resistance which is responsible for inflammation of arteries and subsequent lifestyle disorders including heart attack and paralysis.

The other challenges at an international level in cardiology involve safer alternatives for surgery and angioplasty. Today, most angioplasties with stenting and bypass surgeries last 6-10 years. We want such procedures to last lifelong, obviously with control of risk factors. Stents are needed which can be resorbed completely.

A large number of patients die because cardiac transplant facilities are not available in many countries, especially the Asian countries. Every country should have all transplants friendly laws so that any patient who dies in an accident with death of brain but living heart ends up as a heart living brain dead donor. In India, thousands of patients die every year for want of a heart donor.

Diastolic dysfunction, heart failure and atrial fibrillation are other new epidemics of the society. In diastolic dysfunction, the heart does not relax properly and leads to breathlessness on exertion. It is again linked to obesity. If not treated in time, it ends up in the enlargement of the left smaller chamber of the heart called left atrium. This over a period of time gets enlarged and ends up into new epidemic of the society called Atrial Fibrillation where the heart beats are irregularly irregular. This is the commonest cause of paralysis in elderly age group.

Most of the lifestyle disorders are also linked to eating high salt diet and/or a diet high in transfats. Every country must come out with its policy and guidelines in which they must restrain various restaurants and hotels from using trans fats in their food and limiting the content of salt in their dishes.

They are also challenges for cardiologists. A cardiologist must practice what he preaches. A patient will not listen to the cardiologist if he ( the cardiologist) is overweight and has abdominal obesity, drinks excessive alcohol or smokes.

Cardiologists internationally also face legal threat. Most of the law suits in the west are on cardiologists, especially linked to the need of putting a stent or doing bypass surgery. Clear cut guidelines should be laid down and an impunity should be given to doctors, if they follow those guidelines.

It is a duty of the cardiological association of every country to come out with transparent and standard guidelines in the treatment of heart diseases and when not to put devices in a patient.

Due to lucrative packages, a large number of cardiologists are shifting towards interventional cardiology. Very few people, a time will come, will remain in clinical, preventive or diagnostic cardiology. It will be sad scenario to watch, if it happens.

Young doctors and medical students should devote their life to combat these challenges. They must learn the principles of vedic philosophy, especially ethical earning.

They must follow the principles of counseling as taught by Lord Krishna to Arjuna. Krishna took 18 counseling sessions. In the first, he only listened, in the second he counseled in great detail, from 3 to 17, he gave reasoning at every stage and in the last session, he revised.

The budding doctors must remember that the word ‘Dr.’ as a prefix is given to them as an honour which differentiates them from the society. These prefixes or suffixes are not even available even to Prime Minister or President of India. They must maintain nobility of the medical profession.

In Islam, one of the five pillars mentioned is compulsory charity. The budding doctors should decide at this stage that throughout their life they will involve in doing 10% of charity on a daily basis.